The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia,
including among adolescents whose intake is more than double the national average
and more than four times the recommended daily amount. Unfortunately, there is insufficient
evidence for effective strategies targeting SSB behaviors among Appalachian youth
in real-world settings, including rural schools. Kids SIP smart ER is a 6-month, school-based,
behavior and health literacy program aimed at improving SSB behaviors among middle
school students. The program also integrates a two-way short message service (SMS)
strategy to engage caregivers in SSB role modeling and supporting home SSB environment
changes. Kids SIP smart ER is grounded by the Theory of Planned Behavior and health
literacy, media literacy, numeracy, and public health literacy concepts. Guided by
the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance),
this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian
middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors
at 7-months among 7 th grade students at schools receiving Kids SIP smart ER, as
compared to control schools. Secondary outcomes include other changes in students
(e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors,
home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed,
along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine
how teachers implement Kids SIP smart ER and the potential for institutionalization
within schools. This paper discusses the rationale for implementing and evaluating
a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors
in Appalachia.